# Interactive and Play-Based Group Education Is Associated with Improvements in Carbohydrate Counting Skills and Self-Care Confidence in Children and Adolescents with Type 1 Diabetes: An Exploratory Study

## TL;DR

An interactive, play-based education program improved carbohydrate counting skills and self-care confidence in children and teens with type 1 diabetes, but did not affect glycemic control.

## Contribution

This study explores the use of interactive, play-based group education to improve diabetes self-management in newly diagnosed children and adolescents.

## Key findings

- Carbohydrate counting skills improved, especially in newly diagnosed children.
- Participants reported increased confidence and independence in diabetes self-care.
- No significant changes in glycemic control were observed despite improved skills.

## Abstract

Background/Objectives: Effective glycemic management from the time of diagnosis is essential in the care of children and adolescents with type 1 diabetes (T1D), as early glycemic patterns can influence long-term health outcomes. Methods: This exploratory study evaluated a one-month interactive, group- and play-based education program designed to enhance food and carbohydrate counting skills among families of children and adolescents with newly diagnosed (ND) T1D (<1 year since diagnosis) or suboptimal glycemic control (SGC) (hemoglobin A1c (HbA1c) > 7.5% (58 mmol/mol)). The intervention included hands-on learning activities in food and carbohydrate counting, and peer interaction to support development of diabetes self-management skills. Data were collected at baseline, post-intervention, and at six-months follow-up through medical records, glucose sensor data, and a questionnaire assessing diabetes self-management skills, dietary practices, and carbohydrate counting. Results: Between September 2022 and April 2024, 55 children and adolescents were enrolled in the ND group and 22 in the SGC group. Post-intervention, carbohydrate counting skills improved, particularly in the ND group. Participants reported greater confidence and independence in carbohydrate counting and insulin dosing, with parents noting sustained benefits at six-months follow-up. No significant changes were observed in glycemic control, including time-in-range and postprandial glucose profiles. Conclusions: In this exploratory study, early interactive and play-based group education was associated with improvements in carbohydrate counting skills and self-care confidence in children and adolescents with newly diagnosed T1D. These improvements were not accompanied by changes in glycemic outcomes. The findings occurred during a complex and transitional phase following diagnosis. Further research is needed to examine sustainability and long-term clinical impact.